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Y3 MedEd > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Define osteoarthritis

A

Slowly progressive degeneration of articular cartilage

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2
Q

RF osteoarthritis (4)

A

Obesity
Occupation
Age
Female gender

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3
Q

What can cause secondary osteoarthritis

A

Inflammatory arthritis
Metabolic conditions
Trauma
Deformity

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4
Q

What deformity can cause secondary osteoarthritis

A

developmental dysplasia of the hip

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5
Q

What metabolic conditions can cause secondary osteoarthritis

A

haemochromatosis, Wilson’s disease

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6
Q

Presentation of osteoarthritis (4)

A

Pain worse at end of day
Asymmetrical joint stiffness, especially after inactivity
Joint crepitus
Restricted activity

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7
Q

Which joints are most commonly affected by OA (6)

A 
Weight bearing joints (hip, knee)
Heavy use (DIP, PIP, 1st CMC, wrist)
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8
Q

What is seen on the hands of OA patients and which one is which (2)

A

Heberdens node DIPJ

Bouchards node PIPJ

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9
Q

What is seen in the X ray of osteoarthritis (4)

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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10
Q

What is seen in the joint aspirate of osteoarthritis (4)

A

Straw coloured fluid

Increased viscosity

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11
Q

RA definition

A

Chronic (>6 weeks), systemic inflammatory disease characterised by symmetrical deforming polyarthritis (>4 joints)

and extra-articular manifestations

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12
Q

How many joints are affected rheumatic arthritis

A

> 4

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13
Q

RF RA (2)

A

HLA DR4 mutation

Smoking

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14
Q

What is the gender ratio of RA

A

1:2

Male to female

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15
Q

What is the standard AI gender ratio

A

1 : 2 (autoimmune)

Male : female

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16
Q

History of RA

A

Pain worse at start of day
Joint stiffness for >1h in morning
Restricted activity

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17
Q

Which joints are affected in RA (6)

A

Small joints of hands (PIP, MCP, wrist – NOT DIP)

Other joints: hip, knee, shoulders

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18
Q

What later deformities are seen in RA (5)

A

Wrist: radial deviation
MCP: ulnar deviation of fingers, Z-deformity of thumb
PIP/DIP: Boutoinniere deformity, Swann neck deformity

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19
Q

Extra-articular manifestations of RA (7)

A 
Rheumatoid nodules
Lymphadenopathy
Eyes: episcleritis
Lungs/hearts: pleuritis (fibrosis) /pericarditis
Amyloidosis
Haematological:
Anaemia of chronic disease
Felty syndrome
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20
Q

What does synovial inflammation lead to in RA

A

Tenosynovitis

Bursitis

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21
Q

What haematological complications of RA can you get (2)

A

Anaemia of chronic disease

Felty syndrome

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22
Q

What is the Felty syndrome triad

A

Splenomegaly
Neutropenia
Anaemia of chronic disease

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23
Q

Systemic symptoms of RA (3)

A

Fever
Wt loss
Fatigue

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24
Q

What is seen in the X-ray of RA

A

Uniform joint space narrowing
Juxta-articular osteopenia
Joint erosions at joint margins
Joint deformity & destruction

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25
Q

What do you test for in the blood of RA (6)

A 
Chronic inflammation:
Anaemia of chronic disease
↑ ESR/CRP
Low albumin
Antibodies:
Rheumatoid factor (IgM against IgG)
Anti-CCP (most specific)
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26
Q

Which antibodies in RA

A 
Rheumatoid factor (IgM against IgG)
Anti-CCP (most specific)
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27
Q

What is primary amyloidosis associated with (3)

A

multiple myeloma, lymphoma, waldenstron’s macroglobulinaemia

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28
Q

What is secondary amyloidosis associated with (4)

A

with RA, IBD/UC, chronic infections (e.g TB)

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29
Q

What is the difference between primary and secondary amyloidosis

A 
Primary amyloidosis (AL amyloidosis)
Deposition of immunoglobin light chain 
Secondary amyloidosis (AA amyloid)
Deposition of serum amyloid A (acute phase protein)
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30
Q

Presentation of amyloidosis (6)

A 
Nephrotic syndrome
Hepatosplenomegaly
Carpal tunnel syndrome + peripheral neuropathy
Periorbital purpura
Restrictive cardiomyopathy (1o)
Macroglossia (1o)
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31
Q

Which presentation of amyloidosis is solely in primary amyloidosis (2)

A 
Restrictive cardiomyopathy (1o)
Macroglossia (1o)
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32
Q

Diagnostic test of amyloidosis

A

Apple-green birefringence under polarised light with Congo Red stain

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33
Q

What are the Seronegative spondyloarthropathies (4)

A

PEAR

Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis
Reactive arthritis

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34
Q

Associations/presentation of the seronegative arthropathies (5)

A

HEADS

HLA B27
Enthesitis
Asymmetrical oligoarthritis with Axial involvement and extra-articular involvement
Dactylitis
Seronegative
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35
Q

Gender distribution of seronegative spondyloarthropathies

A

Men more commonly

36
Q

Age and sex of AS

A

Affects young men (<40yrs)

37
Q

Extraarticular manifestations of AS (3)

A

Anterior uveitis
Apical lung fibrosis
Aortic regurgitation

38
Q

Where does AS affect

A

Affects spine (enthesitis) and sacroiliac joints (arthritis):

39
Q

What happens in AS (4)

A

Gradual onset pain and morning stiffness

Eventually bone fusion, and loss of spinal movement

40
Q

What changes to posture do you se in ankylosing spondylitis

A

Question-mark posture: loss of lordosis, kyphosis, neck hyperextension

41
Q

Bloods to take in AS and what is seen in it

A

ACD, ESR/CRP, albumin

42
Q

Best Ix for AS

A

MRI most sensitive

43
Q

What is seen in X-ray of mild (1) and late (2) AS

A

Mild: sacroilitis
Late: syndesmophytes & bamboo spine

44
Q

What is reactive arthritis

A

Sterile inflammation ~2 weeks after extra-articular infection

45
Q

Which infections can cause reactive arthritis

A 
GU infection (chlamydia, gonorrhoea)
GI infection (shigella, campylobacter)
46
Q

What triad is seen in reactive arthritis

A

Arthritis:
Asymmetrical oligoarthritis of lower limbs + spondylitis

Enthesitis:
Dactylitis, Achilles tendonitis, plantar fascitis

Reiter’s syndrome
“Can’t see, can’t pee, can’t climb a tree”
Conjunctivitis, urethritis, arthritis

47
Q

What is Reiter’s syndrome

A

Reiter’s syndrome
“Can’t see, can’t pee, can’t climb a tree”
Conjunctivitis, urethritis, arthritis

48
Q

What enthesitis manifestations is seen in reactive arthritis (3)

A

Dactylitis, Achilles tendonitis, plantar fascitis

49
Q

Which organisms are usually involved in septic arthritis and which is more likely in which patient (2)

A

Staph. Aureus >30yrs

Neisseria gonorrhoea <30yrs

50
Q

Main 2 RF of septic arthritis

A

Joint damage

Infection risk

51
Q

What forms of joint damage can lead to septic arthritis (3)

A

Rheumatoid arthritis; prosthetic joint; gout

52
Q

Which people are prone to infections that can lead to septic arthritis (3)

A

Immunosuppression; diabetes; IVDU

53
Q

Presentation of septic arthritis (4)

A 
Acute monoarthritis, usually affecting the knee:
Exquisite pain
Redness and swelling
Restricted ROM
Fever
54
Q

Which joint does septic arthritis usually affect

A

Knee

55
Q

Which Ix for septic arthritis and what results

A 
Bloods: ↑ WCC, ↑ CRP
Joint aspirate (before ABx):
Turbid, yellow
Low viscosity
↑ WCC (neutrophils >90%)
MC&amp;S
56
Q

What is the crystal in gout

A

Monosodium urate crystals

57
Q

What is the crystal in pseudogout

A

Calcium pyrophosphate crystals

58
Q

What is the typical gout patient

A

Obese, middle-aged men

59
Q

What is the typical pseudo-gout patient

A

Elderly women

60
Q

What are the two presentations of gout

A

Acute monoarthritis
Classically 1st MTP (podagra)
Precipitated by: trauma, infection

Chronic tophaceous gout:
Polyarticular arthritis
Tophi deposits
Urate kidney stones

61
Q

What is the two presentations of pseudo-gout

A

Acute monoarthritis
Classically large joints (knee)
Precipitated by: trauma, illness

Chronic CPPD
Polyarticular arthritis

62
Q

Which joint(s) does gout typically affect

A

Classically 1st MTP (podagra)

63
Q

Which joint(s) does pseudogout typically affect

A

Classically large joints (knee)

64
Q

RF for gout (3)

A

Hyperuricaemia
↑ intake: alcohol
↑ production: tumour lysis syndrome
↓ excretion: diuretics

65
Q

RF for pseudo-gout (7)

A

Idiopathic
HyperPTH, hypoPO4, hypoMg
Metabolic: haemochromatosis, Wilson’s, acromegaly

66
Q

Metabolic causes of pseudo gout

A

haemochromatosis, Wilson’s, acromegaly

67
Q

Precipitants of gout (2)

A

Precipitated by: trauma, infection

68
Q

Precipitants of pseudo-gout (2)

A

Precipitated by: trauma, illness

69
Q

Bloods of gout (3)

A

↑ WCC
↑ CRP
Uric acid after 4-6 weeks

70
Q

Bloods of pseudogout (2)

A

↑ WCC

↑ CRP

71
Q

How long for uric acid to be raised in gout

A

4-6 weeks

72
Q

What is seen in the joint aspirate of gout

A

Turbid, yellow fluid
Low viscosity
↑ WCC (↑ neutrophilis)

73
Q

What is seen in the joint aspirate of pseudo gout

A

Turbid, yellow fluid
Low viscosity
↑ WCC (↑ neutrophilis)

74
Q

What is the result under polarised light of gout

A

Polarised light:

Needle shaped, negatively birefringent

75
Q

What is the result under polarised light of pseudogout

A

Polarised light:

Rhomboid shaped, positively birefringent

76
Q

What is seen in the X-ray of gout

A

Rate-bite erosions

77
Q

What is seen in the X-ray of pseudogout

A

White lines of chondrocalcinosis

78
Q

What is osteomyelitis

A

Infection of bone

79
Q

What is most common organism in osteomyelitis

A

Staph aureus

80
Q

What are the three ways of acquiring osteomyelitis

A

Haematogenous spread
Contiguous spread
Direct inoculating

81
Q

Which patients are most at risk of haematogenous spread of osteomyelitis

A

IVDU
Immunosuppression
Diabetes
Sickle cell (Salmonella)

82
Q

Presentation of osteomyelitis (3)

A

Inflammation (pain & swelling)
Reduced mobility
Fever

83
Q

Which bones commonly get osteomyelitis in children

A

Long bones

84
Q

What is TB osteomyelitis of the vertebrae known as

A

Potts disease

85
Q

Which bloods do we take for suspected osteomyelitis (3)

A

↑ WCC
↑ ESR/CRP
Blood cultures

86
Q

Which Ix is the most sensitive for osteomyelitis

A

X-ray

Y3 MedEd (34 decks)

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